BackgroundNaturalistic Developmental Behavioral Interventions (NDBIs) for young children with autism spectrum disorder commonly involve caregiver‐mediated approaches. However, to date, there is limited research on how caregivers' skills change, and, in turn, impact child outcomes.MethodsWe evaluated the NDBI strategy use of 191 caregivers prior to participation in NDBIs (or control groups) across multiple randomized controlled trials, using the Measure of NDBI Strategy Implementation, Caregiver Change (MONSI‐CC). Clustering analyses were used to examine caregiver variability in NDBI strategy use at intervention entry. Generalized Linear Mixed Models were used to examine changes in caregiver strategy use over the course of intervention and its impact on changes in children's social communication.ResultsUsing clustering analysis, we found that caregivers' baseline skills fit four profiles: limited, emerging, variable, and consistent/high, with few demographic factors distinguishing these groups. Caregivers starting with limited or emerging skills improved in their strategy use with intervention. Caregivers starting with more skills (consistent/high or variable) maintained higher skills over intervention. Children of caregivers in these groups who received target NDBIs improved in their social communication skills.ConclusionsResults suggested that caregiver skills improve through participation in NDBIs and may directly contribute to their children's outcomes, although more research on mediating factors is needed. Individualized approaches for caregivers and their children starting with differing skill profiles at intervention entry may be warranted.

中文翻译：

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检查自闭症谱系障碍儿童护理人员使用自然发展行为干预策略的变异性


背景针对患有自闭症谱系障碍的幼儿的自然发展行为干预（NDBI）通常涉及照顾者介导的方法。然而，迄今为止，关于看护者技能如何变化以及反过来影响儿童结局的研究有限。方法我们在多个随机对照试验中评估了 191 名看护者在参与 NDBI（或对照组）之前的 NDBI 策略使用情况，使用 NDBI 战略实施措施、护理人员变更 (MONSI-CC)。聚类分析用于检查护理人员在干预进入时使用 NDBI 策略的变异性。广义线性混合模型用于检查干预过程中看护者策略使用的变化及其对儿童社交沟通变化的影响。结果使用聚类分析，我们发现看护者的基线技能符合四种情况：有限的、新兴的、可变的和不确定的。一致/高，几乎没有人口因素来区分这些群体。护理人员从有限的或新兴的技能开始，通过干预提高了策略的使用。具有更多技能（一致/高或可变）的护理人员在干预后保持了更高的技能。这些群体中接受目标 NDBI 的照顾者的孩子的社交沟通技能有所提高。结论结果表明，照顾者的技能通过参与 NDBI 得到提高，并可能直接有助于孩子的结果，尽管需要对中介因素进行更多研究。可能有必要为护理人员及其孩子在干预介入时从不同的技能状况开始采取个性化方法。